Provider Demographics
NPI:1750141610
Name:MA, WENJUN
Entity type:Individual
Prefix:
First Name:WENJUN
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W CAMPBELL AVE STE D36
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1041
Mailing Address - Country:US
Mailing Address - Phone:408-666-8105
Mailing Address - Fax:
Practice Address - Street 1:1 W CAMPBELL AVE STE D36
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1041
Practice Address - Country:US
Practice Address - Phone:408-601-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician